Cannabis - Medicinal Use

What is Cannabis?

Cannabis is a durable hemp plant. The cannabis plant can be used to produce a number of products including seeds, pulp, and medicine. The pulp is used as fuel and to make paper, the seed is used in foods, and the oil from the seed can be used as a base for paints and varnishes. The blossoms and leaves of the hemp plant produce a sticky resin, which has historically been used in a variety of medicinal functions, and for just as long, for recreational drug use.

The compound which gives cannabis its depressant and mood-altering properties is known as THC.

Some people believe that cannabis has positive therapeutic qualities and is felt to be particularly useful for certain conditions, such as multiple sclerosis.

Background

In the early 1900s cannabis was popular both as a recreational and a medicinal compound, and there are suggestions that Queen Victoria was given cannabis by her doctor to relieve period pain. The development of superior alternatives, such as the invention of the syringe for rapid drug inducement and the development of aspirin, alongside the failure to develop a standardised product and the poor rate of absorption from oral inhalation, led to the reduced use of cannabis in medicine.

Cannabis was first made illegal in the UK in 1928, and medical use was outlawed in 1973. However, during the 1980s and 1990s, cannabis was increasingly used as a recreational drug, and medical interest in cannabis and its derivatives (cannabinoids) began to grow, principally on the strength of anecdotal evidence from illegal self-medication.

A number of reports about cannabis were published during the late 1990s: by the British Medical Association (1997), the US National Institutes of Health and the American Medical Association (1997) the Department of Health (1998) and the House of Lords Science and Technology Select Committee (1998).

The Select Committee report found cannabis was being used by people with multiple sclerosis, epilepsy, ME and pain, and as an anti-emetic after chemotherapy, and claimed that this was "sometimes connived at by the medical professions".

The report recommended allowing the use of cannabis in some circumstances, but the proposals were rejected by the Government. Although policy remained unchanged, a 2001 follow-up report suggested that the Government's attitude was changing, stating: "the Minister assured us that once a safe, effective, cannabis-based medicine had been licensed by the Medicines Control Agency, the Government would actively co-operate in permitting it to be prescribed."

In 2002, Home Secretary David Blunkett announced that he might permit the medical use of cannabis if clinical trials of the drug were successful.

September 2003 saw the Netherlands become the first country in the world to explicitly legalise the use of cannabis for medical purposes and to licence its production and sale through pharmacies. In the USA, the Food and Drug Administration has approved the oral use of dronabinol, a cannabis derivative, for people with AIDS, as a means of restoring appetite.

In January 2004, the Home Office downgraded cannabis from a Class B to a Class C drug for all purposes, but this decision was reversed in May 2008 by Home Secretary Jacqui Smith who announced that cannabis was to be reclassified as a Class B drug.

It remains illegal to carry, smoke or possess cannabis in any form, but the police usually will not arrest or prosecute people found in possession of small amounts intended for personal use.

In June 2010 the Medicines and Healthcare products Regulatory Agency (MHRA) granted GW Pharmaceuticals a licence to market the first cannabis-based prescription medicine in the UK. 'Sativex' is a mouth spray which contains cannabinoids and is used to treat spasticity in people with multiple sclerosis. Research is also being conducted into the use of 'Sativex' for cancer pain and neuropathic pain of various origins. The clinical and cost-effectiveness of the spray is still being assessed by NICE; the result of the appraisal is expected in January 2012.

Controversies

Despite its potential medical value, cannabis has long been thought to have harmful mental health side-effects, with many scientific reports linking it to depression, schizophrenia and other conditions.

There have been a number of high profile prosecutions of medicinal cannabis users in the UK, and the Science and Technology Committee report warned of regional variations in the verdicts and sentences handed down, or 'postcode prosecuting'. Figures and trends have been difficult to extrapolate, however, as the Home Office does not record instances in which therapeutic use is pleaded in mitigation.

Therapeutic use prosecutions are particularly controversial given the seriousness of some of the conditions of the users, including cancer, AIDS and MS, which has generated public sympathy for a change in the law. However, the large quantities, steady supplies and high quality of the product required by medicinal users has tended to make their cases more difficult for the authorities to ignore than casual users.

Medicinal use is one of the leading positive factors cited by those calling for legalisation of cannabis. Indeed, a synthetic form of THC - Nabilone has been licensed for use as an anti-emetic in prescription drugs since 1982. The drugs industry has also been developing aerosol sprays for delivering THC directly to the lungs without the health risks of smoking.

The criminalisation of those using cannabis for medicinal purposes has been a particularly controversial issue - with opponents questioning the social purpose and moral value of the law that punishes individuals merely for seeking an effective form of pain relief not available from conventional, legal sources.

Statistics

Cannabis was reclassified from Class C to Class B in January 2009.
The maximum penalty for supply, dealing, production and trafficking is 14 years imprisonment.
The maximum penalty for possession is five years imprisonment.

Source: Home Office - 2011

The cost of 'Sativex' to the NHS is £125 per 10ml vial. This works out on average at £11 per person per day, based on 8 sprays per day.

Source: MS Society - 2011

Quotes

"GW was founded with the primary goal of developing a medicine to address the unmet needs of people with MS and today's launch of Sativex® represents a welcome advance in MS symptom treatment...Today's news validates our cannabinoid technology platform and enables us to progress the development of our pipeline across a range of therapeutic areas with increased confidence."

Dr Geoffrey Guy, chairman GW Pharmaceuticals - 2010

"All cannabis-based products are controlled drugs under the Misuse of Drugs Act and, therefore, the MS Society does not support or encourage the purchase, production or distribution of illegal cannabis under any circumstances."

MS Society; policy position statement on cannabis.

"Smoking cannabis can make existing psychosis worse. Its calming effects can reduce fear and anxiety in the short term, but it can cause relapse and increase the risk of developing uncontrollable muscle spasms and twitches. Because cannabis also contains mind altering chemicals it can reduce the effectiveness of antipsychotic medication."

Rethink mental health charity - 2011